Late last week, the U.S. surgeon general issued a report that directly linked alcohol consumption to seven different cancers and suggested that alcoholic beverages should be affixed with cancer warning labels. The guidance was a bombshell to many, but as a medical oncologist who has repeatedly experienced the nexus between alcohol and cancer, I was not surprised at the advisory. In fact, it was long overdue.
As Surgeon General Dr. Vivek Murthy wrote in introducing the new advisory, “Alcohol is a well-established, preventable cause of cancer responsible for about 100,000 cases of cancer and 20,000 cancer deaths annually in the United States — greater than the 13,500 alcohol-associated traffic crash fatalities per year in the U.S. — yet the majority of Americans are unaware of this risk.”
Alcohol sets the body on a pathway for cancer through various mechanisms.
This knowledge is especially important given alcohol’s enduring presence in American culture. With more and more data showing that no level of drinking (light or heavy) is fully safe from cancer, we should hasten efforts to raise awareness and to enact public policy measures that can curb alcohol consumption and save lives.
Alcohol use is far-reaching in the United States. In 2023, the National Survey on Drug Use and Health found that 79.1% of individuals aged 12 and older had drunk alcohol at some point in their lifetimes; 62.5% reported drinking in the past year and 47.5% imbibed in the past month.
This level of consumption didn’t just become concerning because the surgeon general said so. The link between alcohol and cancer has been known for decades now.
In 1987, the International Agency for Research on Cancer first classified alcohol as carcinogenic to humans. The IARC put alcohol in Group 1, the highest risk group, alongside tobacco. Since then, other cancer organizations, like the influential American Society of Clinical Oncology (ASCO) have supported this finding.
But their statements have largely failed in gaining traction from the greater medical community and general public. A 2022 study found that less than a third of U.S. respondents recognize that alcohol raises cancer risk. More concerning was the lack of association made with specific alcoholic beverages like beer (25%) and wine (20%).
Alcohol sets the body on a pathway for cancer through various mechanisms. It damages DNA in many ways through a metabolite (acetaldehyde), changes levels of multiple hormones like estrogen, leads to increased absorption of carcinogens and causes a rise in inflammation through oxidative stress. The presence of alcohol has been linked to increases in the following seven cancers: mouth, pharynx, larynx, esophagus, breast, liver and colorectal.
While there may be no zero-risk threshold, it remains important to emphasize that less alcohol is still better than more.
While the health consequences of heavy alcohol consumption are well substantiated in the cancer data, it is especially critical for the public to understand that even light and moderate drinking carry a very real and measurable danger. As Dr. Ernest Hawk of the MD Anderson Cancer Center told The New York Times, “There is no safe level of alcohol when it comes to cancer risk.”
Several studies have confirmed that even light to moderate drinkers develop an increased risk for alcohol-related cancers. For females, even one drink per day has been found to make breast cancer likelier than those who abstain. While there may be no zero-risk threshold, it remains important to emphasize that less alcohol is still better than more. According to the surgeon general’s report, the risk for breast cancer rises by 4% when alcohol consumption increases from drinking less than one drink per week to two drinks per day. As Dr. Murthy told The Washington Post, “Over the population, that’s a lot of women who would develop breast cancer. At the population level, that kind of change, even though it might seem small by the numbers, actually really does matter.” Discussing such dangers and obtaining a detailed drinking history from patients, especially those with a family history of cancer, is imperative. But it also extends further to cancer survivors and those currently under active treatment with chemotherapy, immunotherapy, etc. A study has shown that when these cancer patients continue to consume alcohol, they risk a recurrence of their disease or compromising the efficacy of their life-saving therapies. Raising public awareness about alcohol’s health risks is the obvious starting point, but it is not a panacea. Public health interventions will also need to be deployed that seek to limit alcohol advertising, reduce availability, add warning labels on alcoholic beverages and raise alcohol taxes and prices. A small but growing number of countries have already heeded this call. And this will take the collective efforts of many in the medical community, including primary care physicians, oncologists and mental health professionals. A national awakening on alcohol and its role in cancer has long been delayed. The surgeon general’s report presents a rare moment to change this. When there is an opportunity to potentially stave off thousands of new cancer diagnoses, the chance should be welcomed.
Dr. Jalal Baig
Dr. Jalal Baig is a physician and writer based in Chicago. His work has appeared in the Washington Post, The Atlantic, Foreign Policy, Guardian, Vice, Slate, Religion News Service and elsewhere. 
